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Updated cannulation technique for tissue plasminogen activator injection into peripapillary retinal vein for central retinal vein occlusion
Author(s) -
Overdam Koen A.,
Missotten Tom,
Spielberg Leigh H.
Publication year - 2015
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/aos.12830
Subject(s) - medicine , central retinal vein occlusion , ophthalmology , vitrectomy , visual acuity , branch retinal vein occlusion , retinal , retinal vein , tissue plasminogen activator , macular edema , surgery
Purpose To update the surgical technique in which a vitrectomy is performed and a retinal branch vein is cannulated and infused with recombinant tissue plasminogen activator ( RTPA ) to treat central retinal vein occlusion ( CRVO ) in patients who present with very low visual acuity ( VA ). Methods Twelve consecutive patients (12 eyes) with CRVO and low VA (log MAR >1.00) at presentation were treated using this method. Results Cannulation of a peripapillary retinal vein and stable injection of RTPA was successfully performed without surgery‐related complications in all 12 eyes. At 12 months after surgery, 8 of the 12 patients (67%) experienced at least one line of improvement in best corrected visual acuity; 6 of the 12 (50%) improved ≥5 lines and 2 (17%) improved ≥8 lines. After additional grid laser and/or subconjunctival or intravitreal corticosteroids, the mean decrease in central foveal thickness was 260 μ m, and the mean total macular volume decreased from 12.10 mm 3 to 9.24 mm 3 . Four patients received panretinal photocoagulation to treat either iris neovascularization ( n = 2) or neovascularization of the retina and/or disc ( n = 2). Conclusion Administration of RTPA via a peripapillary vein using this updated technique provides an alternative or additional treatment option for patients with very low VA after CRVO .